Continuous Perineural Anesthesia

Continuous perineural analgesia is the placement of a small tube (catheter) around a nerve or group of nerves in order to provide you relief from pain after surgery of your arm or leg. The tube will be connected to a machine (infusion pump) that will give you medicine continuously. This local anesthetic solution will help relief your pain and make your arm or leg feel somewhat numb and weak. This is normal and is due to the effects of the nerve block.

• To better control your pain when compared to only giving medication through your vein (intravenous (IV) medication)
• To reduce the need for pain medicine and help prevent some of their side effects
• To make it easier and sooner for you to start moving and exercising (physical therapy)

You will be seen by an anesthesiologist who will make sure that you are safe and comfortable during and following surgery. He or she will talk to you and answer all of your questions about this procedure, the tube, and the pump.

We will watch you closely during the procedure. We will give you oxygen (air) and medicine to help you relax. The doctor will place you in the appropriate position for the nerve block. Before the procedure starts, the doctor will find the appropriate spot to place your tube and clean your skin. You may feel some pressure or pain from the medicine that is put on your skin and during placement of the injection and tube. Sometimes, the needle may touch a nerve, causing a brief tingling feeling down the area where the block is being performed. The needle may also be used to check for muscle twitches in the area where surgery will occur. After the tube is in place, it will be taped to your skin and connected to the pump.

The pump will send the pain medicine your doctor ordered for you to your body. You will have a button that is attached to the pump that you can push to get additional pain medicine when you need it. In addition, as soon as you can drink and eat again after surgery, you will have pain medication given by mouth that you can take as needed. You still may have some pain because we can not take away all of the pain. We will try to make you as comfortable as possible.

Nerve block procedures are very safe, but there are some risks:

Any time a needle or tube is placed under the skin, pain, bleeding or infection at the site may occur. This is not very common.

Because of the numbness and weakness of your arm or leg, you need to be careful with what you try to do with it. While your arm is numb you should wear a sling while you walk or do any activity. While your leg is numb, you should use assistance and crutches in order to get around. You should ALWAYS follow the instructions given by your doctors and nurses with regards to your activity while your recover from your surgery.

Sometimes the numbness and weakness lasts for awhile after the tube is removed. At times you may still feel this way for another day or two. This is normal.

You will be under the care of an anesthesiologist while the tube is being placed and during your surgery. We will watch you closely throughout.

Once you are moved to your room after surgery, the nurses will check on you and the pump. A member of the acute pain service will also check on you each day to make sure you are comfortable. You will also be able to press the nurse call button whenever you need any help or additional pain medication.

We want to provide you with pain relief for as long as you need it. We encourage you to move, sit up in bed, and be as active as soon as possible while the tube is in place. For most patients, once we can get you comfortable with pain medications given by mouth we will remove the tube. This commonly takes one to three days. Some patients may be sent home with the catheter and pump. Those patients will receive detailed instructions as to when and how to remove the catheter.